Provider Demographics
NPI:1285449918
Name:INFUSION CLINIC OF CENTRAL TEXAS PLLC
Entity type:Organization
Organization Name:INFUSION CLINIC OF CENTRAL TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-667-7123
Mailing Address - Street 1:1340 WONDER WORLD DR STE 2203
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1340 WONDER WORLD DR STE 2203
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7791
Practice Address - Country:US
Practice Address - Phone:512-667-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty